Healthcare Provider Details

I. General information

NPI: 1902283674
Provider Name (Legal Business Name): JABRIL ROLLINS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date: 07/06/2018
Reactivation Date: 07/10/2018

III. Provider practice location address

555 FRANKLIN ST
SAN FRANCISCO CA
94102-4414
US

IV. Provider business mailing address

240 3RD ST
OAKLAND CA
94607-4376
US

V. Phone/Fax

Practice location:
  • Phone: 628-900-3414
  • Fax:
Mailing address:
  • Phone: 562-413-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: